Sunday, September 6, 2009

in Iquitos


An Amazon Promise banner against HIV



Belen, the poorest part of Iquitos


The headquarters of Amazon Promise are in Iquitos, the jungle city in the midst of the Peruvian rain forest. It is hot and humid here as usual, or even more so, as I hear the IguiteƱos complain (the coplaints about the heat are an indelible part of the local culture; however, this time they may be justified--it is over 100F daily and over 90% humidity). On the way from the airport, the taxi driver tries to avoid the morning motorcar and motorcycle traffic coming on us from every direction, all at once. We end up in Belen, the poorest part of the city, and I am instantly reminded of how life happens here: the shanty shacks whose rotten doors lead to dark, dirty corridors with empty rooms, the dessicated grandmas sitting on the doorsteps chewing on a piece of mango skin, the nothingness of powerty...this juxtaposition with the world I have just come from cannot be more pressing. After I arrive, Lupe, one of the local HIV promoters and a woman living with HIV for four years, informs me of this year^s inofficial count of HIV infections and deaths in Iquitos : over 200 cases registered at the two hospitals where antiretrovirals are distributed, and counting. This is a very rough estrimate since no one accounts for the men and women who are living with HIV and have never been tested, or have never been registered...time to get to work!

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Patient Stories

Juan: A Patient’s Story

During an Amazon Promise clinic in the village of Jerusalen, we met a desperate, emaciated man who was holding the hand of a four-year-old boy with cutely unkempt hair. Having been sick for some time, Juan had come to the village from Iquitos in the hopes of finding some healing in traditional jungle medicine. He was a very humble man who never looked into anyone’s eyes. His son was the shyest of kids. There was tenderness between them. The AP clinic doctors could not find the source of Juan’s fatigue, but suspected that he was in the end stages of HIV/AIDS infection. We offered to help him get back to Iquitos for HIV testing.

In Iquitos, Juan tested HIV positive and broke down. We counseled him about the free antiretroviral treatment he could receive from one of the hospitals. Still, he was convinced that an HIV diagnosis meant certain death. Juan then revealed he had a wife and another child. In fact, he was not afraid to die, but he was petrified that they too might be infected. At the San Juan Health Center in Iquitos, Juan’s wife and their children tested negative, while Juan’s tests confirmed his HIV infection. Again Juan cried, but this time with relief. Nevertheless, his joy was short-lived: he now perceived himself a burden to his family, and craved death. At that point, he could hardly walk. Together with his wife, we counseled him and finally convinced him to start treatment. His wife was very strong, forgiving and caring. They decided to make it together.

Juan entered the free antiretroviral treatment program at the Hospital Regional. Because he was too ill to work, his wife took on an extra shift at her job to make ends meet.

A year later, while we were visiting the same village, an elderly woman spoke without stopping about how fat her son Juan was getting. Then one day Juan rang the bell at the Amazon Promise house in Iquitos. He walked in with muscled arms and a protruding belly, holding his youngest child in his arms and the boy with unkempt hair by the hand. Juan has a full-time job now. He looks people straight in the eye, and talks with great concern about the growing number of HIV patients he sees in the hospital where he receives his treatment. At the moment, he is training to become a volunteer HIV-prevention counselor. Welcome back to the world, Juan.

(The patient’s name has been changed for the sake of confidentiality)

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